Homeopathic Materia Medica by Dunham

THE ANAMNESIS

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In my last lecture I tried to explain the nature ot the series of symptoms which make up a case of sickness; the different kinds of symptoms, and how to observe and get a knowledge of them; the different value of symptoms, depending on the object which you have in view when you are studying them. I endeavored to show the importance of an independent study of symptoms as a distinct branch of the science of biology, without reference to the practical application of the art of curing. And, finally, I showed how the totality of the symptoms when obtained, was practically made available for the selection of the remedy, by being compared with the symptoms produced by drugs in the healthy subject; that drug being selected which had produced symptoms most similar to those of the case; and I showed how it must be that sometimes it is apparently trivial symptoms which determine the choice between one and another drug.

It may have occurred to some of you, as it must have occurred to all who, having had practical experience in the homeopathic treatment of disease, did me the honor to be present at my lecture, that I took no notice of a very important feature in the examination of the case,—a most important element of the case,—viz.: the previous history or the anamnesis, as it is called.

As a matter of course, in our investigations for the purpose of forming a diagnosis and a prognosis, the previous history of the case and OF the patient before he became ill must have received our earnest attention. But it has not yet appeared, from what I have said, what part the history of the case is to play in enabling us to select the appropriate remedy. To this subject, as it is both very important and not always clearly understood, I shall devote much time this morning.

You will please bear in mind that the process by which we accomplish the selection of the remedy for a case of sickness, is a process of comparison. We compare the symptoms of the case with the symptoms which drugs have produced in the healthy; and we select the drug of which the symptoms are most similar to those of the patient. We seek a parallelism between drug symptoms and those of the patient.

You will remember also that the symptoms of a case of sickness, like the physiological phenomena of persons healthy, are not always and during all time the same; they vary from day to day, from hour to hour, or from minute to minute. Indeed it might properly be said that life is, in so far as every physiological process is concerned, a series of oscillations within physiological limits; now action is vehement, now mild; waste is now in excess, now in deficit. Just so is it with morbid phenomena or symptoms, whether they be of natural, or of artificial or drug, disease. We are then instituting comparisons between, so to speak, oscillating and continually shifting series of phenomena. Now, the point of importance here is that this oscillation and shifting require time, and that therefore our summary of the symptoms must cover not merely the moment of time at which we observe the patient, but also some previous time during which the symptoms may have been different from those of the present time. This remark applies both to the drug and the case. It is necessary not simply for the purpose of getting a full picture of the case, but also to make certain that there is a complete parallelism between the case and the drug we think of giving the patient.

Two lines, each an inch long, may appear to be parallel. If we would be certain whether or not they are so, let us project each line until it is a foot long. We shall then more easily see the divergence or convergence if there be any. Just so, at some particular moment, the symptoms of a case and of a drug may appear to be very similar; but if we compare the succession and order of the symptoms, for the space of a day or two, with the succession and order of the drug symptoms, we may notice a marked difference. This is illustrated by comparing the symptoms produced by two drugs in the healthy proven There is a period in the action of each, when, to my mind, the symptoms of Aconite and Carbo vegetabilis are very similar, and yet, taking a broader view of these drugs, we can hardly find any more unlike.

Shall I shock any of my hearers by stating this necessity for taking into consideration the course and succession of symptoms in selecting a remedy; and shall I be told that strict homeopathy requires that a prescription shall be made for the symptoms that are present, the remedy to be changed when the symptoms change ? I believe that some conscientious physicians too closely follow this method— too closely for the best success. Let us take a practical instance; a case of intermittent fever. The patient has certain symptoms which precede and usher in the chill. Then, for two hours or more, he has the symptoms which constitute the chill; then, after an interval, those which constitute the hot stage; then those of the sweating stage; after which comes a period of from ten to forty hours, constituting the apyrexia, during which the patient probably may have some symptoms which serve to characterize his case, and individualize it. We may see the patient during one or all of these periods. His symptoms at the different times are certainly very different. Is it our custom, is it good practice, to give the patient a different remedy, corresponding to each of these stages ; or, would the nicest faculty of selection lead us to select for each stage the same remedy, to which a survey of the whole case would bring us ? The former is not our custom. It would not be good practice. We could not so select. On the contrary, we extend our lines of symptoms—unless they correspond with the complete paroxysm and apyrexia— and then we can judge of their parallelism. We seek a remedy which produces just such cold, hot and sweating stages in just such order and with just such concomitant symptoms, and that likewise produces such symptoms in the apyrexia. Do you point me to cases in which no such parallelism is found, and yet a successful prescription is made ? I reply that, as I said at first, we are like the Israelites, and must make bricks whether we have straw or not. We must prescribe from our materia medica as it is. Where we can do no better, we must prescribe on a few symptoms, on an inference or an analogy, rather than refuse to prescribe at all. Yet nobody will deny the greater certainty of the prescription when such a parallelism can be established. In such a case, then, we follow the patient along a series of violent oscillations between cold, heat, sweat, and the normal state again. And this we do, to a greater or less extent, in very many illnesses in which the oscillations are not so violent.

I believe that a broad enough consideration of this subject would lead physicians to abstain from alternation of remedies even in the few instances in which Hahnemann sanctioned it, and would deter them from the error, as I deem it, of leaving a patient several remedies to be taken, variously, as different phases of sensation or objective phenomena succeed each other. But to be able to prescribe in this large-viewed way for your patient, you must have studied the materia medica in the same comprehensive way; you must have studied the connection and succession of the symptoms. A mere repertory study for the case in hand will not suffice. You must have made a systematic study of each drug and of each group of drugs.

Now I see no reason, especially in chronic diseases, why this method of taking into consideration the oscillations of symptoms should be limited to a few days or a week. If a patient present himself, having a fever at night and chilliness by day, we comprise these oscillations in one group, and seek a remedy which presents a parallel group. If, now, we find a patient who has a certain set of symptoms in the summer, which uniformly gives place to another set in the winter, and these again are replaced in turn by the summer set, why should we of necessity restrict our view in the summer to the symptoms of that season only, and in winter the same, when we might by a broader view comprehend both under one prescription ? It is a practical question. Can it be done ? I answer from experience, it can; and let me tell you an advantage. The symptoms of one season may be so vague and indefinite that you cannot find a remedy for them, just as in the intermittent the symptoms of one stage may have so little about them that is characteristic that you cannot select a remedy. But, perhaps, the symptoms of the other season, the summer, are so characteristic as to leave no doubt of the remedy. Then, if you believe in this unity of disease, you may in the winter prescribe on the strength of the summer symptoms, although these disappeared months ago and will not recur for months to come, and you may effect a radical cure. I shall presently illustrate this by a case.

Let me say further, that if this be a correct method of prescribing, we may extend it, and instead of requiring a succession of oscillations, even at so distant intervals as summer and winter, we may regard an acute attack of illness and the chronic condition which follows it as one series of phenomena, and prescribe as for one present malady, even though years have passed since the acute attack of illness was merged into the chronic affection. I shall illustrate this point by two cases.

I come now to a third kind of case, in which a family predisposition to the recurrence of a certain form of disease at a certain period is so marked, that we may consider indefinite and vague symptoms as indications that the tendency is working to development, and may prescribe for it in anticipation. I should not venture upon this statement had I not a case to present in illustration of it. Let me repeat that the advantage of these methods lies in the fact alone that they give us data for a sure prescription, whereas otherwise we should be unable to find a basis for a prescription. I will now relate cases.

1. E.W.D. Headache in winter, nondescript diarrhoea in summer, indicating Aloes. I prescribed Aloes in the winter, on the strength of the summer diarrhoea, and cured both.

2. The case of G.W.W., jr. Deafness from milk-crust. I prescribed Mezereum for the milk-crust, and the deafness never returned. He is now attending to business.

3. A case of epilepsy, I prescribed Platina, on the strength of previous strong passion and peculiar disposition ; imperious and high stepping.

4. The case of Mrs. B. was one of supposed uterine disease ; she had been treated by caustics, etc. She complained of aching in the heels, and I suggested Agaricus. The whole family had spinal meningitis; two brothers had died, and a sister was paraplegic. Agaricus cured the uterine disease.